Full Name		Email Address
Today's Date		Occupancy Date
Daytime Phone		Evening Phone
Cell Number		Home Address

NOTE: please be as specific and accurate with description as possible.

Item No.	Room	Description
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Note: Listing an item on this form does not constitute it as a warrantable/serviceable item. Any item may be checked by our service representative to deem whether or not it is warrantable/serviceable under the Tarion guidelines. We reserve the right to invoice for any service charges we receive resulting from unnecessary service calls.

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